ADVANCE ENGLISH FOR NURSING GROUP TASK

"Safety and Accident Prevention"

Lecturer:
Sapto Dwi Anggoro, M.Pd

Lecturer Facilitator:
Nurul Arifah, Skep., S.Pd.Ns., M.Kep., M.TEFL

Arranged by:
1. Agung Laksmana NIM 161,0006
2. Intan Cahya Puspita Loca NIM 161,0048
3. Nadia Ayu Kusuma Astuti NIM 161.0066
4. Nandika Ayu Nur Faradilla NIM161.0068
5. Uzlifatul Khisbiyatul K NIM 161.0104

STUDY BACHELOR PROGRAM OF NURSING

HANG TUAH COLLEGE OF HEALTH SCIENCES SURABAYA
YEAR 2019

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 CONTENTS

Cover ................................................................................................................. i
Table of Contents .............................................................................................. ii

A. General Overview ........................................................................................ 1

B. Case Study .................................................................................................. 3

1. Definition ................................................................................................ 3
2. Classification ........................................................................................... 3
3. Etiology ................................................................................................... 4 .
4. Pathophysology ....................................................................................... 4
5. Clinical Manifestations of Femur Fractures ............................................ 5
6. Supporting Examination .......................................................................... 5
7. Management of Femur Fractures............................................................. 6
C. The Concept of Nursing Care at Femur Fractures .................................. 7
D. Refences ........................................................................................................ 34

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A. General Overview
According to Husni (2010: 152), work safety is related to workplace accidents,
namely accidents that occur in the workplace or known as industrial accidents. This
industrial accident in general can be interpreted as an unexpected and undesirable event
that disrupts the process that has been arranged from an activity.
Based on Undang-Undang No.1 tahun 1970, work safety requirements which are
also the government's goal to make K3 rules are:
1. Prevent and reduce accidents.
2. Prevent, reduce and extinguish fires.
3. Prevent and reduce the danger of blasting.
4. Give a chance or a way to save yourself during a fire or other dangerous event.
5. Give help to an accident.
6. Give self protection tools to workers.
7. Prevent and control the rise or spread of temperature, humidity, dust, dirt, smoke,
steam, gas, gusts of wind, weather, radiation, sound and vibration.
8. Prevent and control the emergence of diseases due to work both physically and
psychologically, poisoning, infection and transmission.
9. Obtain sufficient and appropriate information.
10. Organizing good and sufficient air temperature.
11. Maintain cleanliness, health and order.
12. Obtaining harmony between labor, work tools, environment, methods and work
processes.
13. Secure and facilitate the transportation of people, animals, plants or goods.
14. Securing and maintaining all types of buildings.
15. Secure and expedite loading and unloading work, treatment and storage of goods.
16. Prevent exposure to dangerous electricity.

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 The legal basis states that this personal protection equipment is Undang-undang
No. 1 Tahun 1970 Bab IX pasal 13 concerning obligations when entering a workplace
that reads: "Whoever enters a workplace, is obliged to obey all work safety instructions
and use the required personal protective equipment."
Health work according to that is "a situation workers who are free from physical
and mental disorders as a result of the influence of work and environment interactions ".
Legal provisions regarding occupational health are also contained in UU Kesehatan No.
23. This Health Law confirms the following matters.
1. Occupational health is held to realize optimal work productivity.
2. Occupational health includes occupational health services, prevention of
occupational diseases, and occupational health requirements.
3. Every workplace must carry out occupational health.
Provisions regarding occupational health as referred to in paragraph (2) and (3)
are stipulated by Government regulations. (Kuswana, 2014)
The steps we can take to prevent workplace accidents occur:
1. Create accident prevention activities as part of our daily activities.
2. Report when finding things that are unsafe to your nearest supervisor / supervisor
3. Avoid joking at work
4. Follow the Instructions / Work instructions / Procedures
5. Suggestimprovement
6. goodinhousekeeping
7. Neatat work
(Husni, 2010)

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B. Study Case
1. Definition
Fractures are fractures, usually caused by trauma or physical energy. The
strength and angle of the energy, the state of the bone itself and the soft tissue
around the bone will determine whether the fracture that occurs is complete or
incomplete. Complete fracture occurs when the whole bone is broken, while in
incomplete fracture does not involve all thickness of the bone (Helmi, 2012)
Fracture of the femur or fracture of the thigh bone is a damage to the groin
contraction that can be caused by direct trauma, muscle fatigue, and certain
conditions, such as bone degeneration or osteoporosis. Femoral bone fractures
can occur from proximal to distal. To break the femur stems in adults, a great
style is needed. Clinically, the femur fracture consists of open thigh bone and
closed thigh bone (Mutaqqin, 2010)
Fractured closed femur is a fracture where the skin is not penetrated by
bone fragments, so that the fracture site is not polluted by the environment. Open
fracture is a fracture that has a relationship with the outside world through injury
to the skin and soft tissue can be formed from inside or from outside (Mutaqqin,
2010)
2. Classification
There are two types of femoral fractures, namely:
a) Femoral intracapsular fractures that occur in the joints , pelvis and through
the head of the femur (capital fracture):
1) Only under the head of the femur.
2) Through the neck of the femur
b) Extractapsular fracture.
1) Occurs outside the joint and capsule, through a larger / smaller trochanter
femur / in the intertrokhanter area.
2) Occurs in the distal direction towards the neck of the femur but not more
than 2 inches below the small trochanter. (Mutaqqin, 2010)
3. Etiology
According to(Padila 2012), the etiology of fractures is as follows:
a) Direct trauma / direct trauma, ie if the fracture occurs in a place where the part
gets forced ruda (such as collisions, blows resulting in fractures)

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 b) Indirect trauma / indirect trauma, that is when trauma is delivered to an area
farther away from the fracture area. for example sufferers fall with arms in an
extension state can occur fractures in the wrist.
c) Even mild trauma can cause a fracture if the bone itself is fragile / there is an
"underlying disease" and this is called a pathological fracture.
4. Pathophysology
Fractures are most often caused by trauma. The hard impact of an accident
involving the bone will cause the bone to become broken and irregular bone
fragments or discontinuities in the bone. (Padila 2012) Femoral
fractures are rare compared to short bone fractures. others because the
periost that coats the femur is thicker than other short bones, especially in the
front area which is covered with thicker skin so that the bone is not easily broken
and due to trauma from the outside so that a fracture of the femur can occur.
(Padila 2012)
5. Clinical Manifestations of Femur Fractures
Signs and symptoms of femoral fracture (mutaqqin, 2010). Namely:
a) Continuous pain and weight gain until the bones are mobilized.
b) Deformity (visible or palpable).
c) In long fractures, there is actual shortening of the bone due to muscle
contraction attached above and below the fracture location.
d) When extremity is examined by hand, palpable crunch of bone is called
crepitus which is palpable due to friction between the fragments of one
another.
e) Swelling and local discoloration of the skin occur as a result of trauma and
bleeding following the fracture.
(Padila 2012)
6. Supporting Examination
The investigation in the case of a femoral fracture is:
a) X-ray examination: determining the location / extent of trauma fracture
b) Bone scan, tomogram, CT / MRI scan: showing fracture, can also be used to
identify soft tissue damage.
c) Arteriogram: performed when vascular damage is suspected.
d) Calculate the complete area: HT may increase (hemoconcentration) or
decrease (white blood cell bleeding is a normal stress response after trauma).

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 e) Creatinine: Muscle trauma increases creatinine load for kidney clients,
coagulation profile, changes can occur in blood loss, transfusion or injury.
(Padila 2012)
7. Management of Femur Fractures
The principle of management of fractures is of two types, namely reduction
and immobilization:
a) Reduction
Fracture reduction means returning bone fragments to their
alignment or anatomical rotation. Closed reduction, returning bone
fragments to the position (the edges are interconnected) with manual
manipulation and traction. Tools used are usually traction, splints and
other tools. Open reduction, with a surgical approach. Internal fixation tool
in the form of pins, wires, screws, plates and nails.
b) Immobilization
Immobilization can be used with the external method and internally
maintaining and restoring the functions of neurovascular status are always
monitored including blood circulation, pain, touch, movement. Estimated
immobilization time needed to connect fractured bones is about 3 months.
(Padila 2012)

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C. The Concept of Nursing Care at Femur Fractures
1. Assessment of Clients Femur Fractures
Clinical manifestations of femoral fractures are similar to clinical
manifestations of common long bone fractures, such as pain, loss of function,
deformity, shortening of lower extremity due to muscle contraction attached
above and below the site of fracture, crepitation, swelling, and local changes in
skin color due to trauma and fracture bleeding. These signs only occur a few
hours or several days after the injury. The assessment of femur fractures
includes:
a. History
Client Identity, including name, gender, age, address, religion,
language used, marital status, education, occupation, blood type, register
number, hospital admission date and time (MRS), and medical diagnosis.
In general, the main complaint in cases of femoral fractures is
severe pain. To obtain a complete assessment of the pain of clients, nurses
can use PQRST. Provoking Incident : the thing that becomes a factor of
precipitation is pain trauma to the thighs.
1) Quality of pain : the client feels pain that is piercing, blunt or cut.
2) Region, radiation, relief : pain occurs in the thigh having a broken
bone. Pain can be reduced by immobilization or resting.
3) Severity (scale) of pain : subjectively, the pain felt by the client
between 2-4 in the measurement scale range 0
4) Time : how long the pain lasts, when, does it increase bad at night or
during the day.
Current medical history. Assess the chronology of the trauma,
which causes a thigh fracture, what help has been obtained, and whether he
has been treated for a broken divorce. By knowing the mechanism of the
occurrence of accidents, nurses can find out about other accident injuries.
Past medical history. Certain diseases such as bone cancer and
paget disease cause pathological fractures so that the bones are difficult to
connect.
Family history. Family diseases associated with thigh fractures are
predisposing factors for fractures, such as osteoporosis.

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 Psychosocial history. Assess the client's emotional response to the
illness, the role of the family in the family and society, and the response or
influence in daily life, both in the family and in the community.
In the assessment phase, nurses also need to know the patterns of
health function in the client's femur fracture nursing process, such as:
1) Patterns of perception and management of healthy life.
2) Pattern of perception and self-concept.
3) Sensory and cognitive patterns.
4) Stress management pattern.
5) Pattern of values and beliefs.
b. PhysicalThe physical
examinationexamination is divided into two, namely general
examination (general status) to get a general description and local (local)
examination. Includes:
General circumstances, the condition of good and bad clients. Signs
that need to be noted are the client's awareness: (apathy, sopor, coma,
anxiety, compost mentis which depends on the client's condition), pain or
state of illness (acute, chronic, mild, moderate, severe, and in cases of
fractures usually acute) , vital signs are not normal because there is a local
disorder, both function and form.
Head: No disruption, no headache
Neck: No swallowing disturbances
Face: Visible pain, symmetry, no lesions
Eyes: Conjunctiva not anemic, nodisorders
ear: No tenderness andbleeding
nose: No deformity
Mouth and pharynx : There is no enlarged tonsil

(1) B1 (Breathing). On examination of the respiratory system, it was

found that the client fractured the femur did not experience
respiratory abnormalities. In chest palpation, fremitus tactics are
balanced right and left. On auscultation, no additional breath
sounds were found.

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(2) B2 (Blood). Inspection: no heart jaundice. Palpation: the pulse
increases, the iktus is palpable. Auscultation: a single S1 and S2
sound, no murmur.
(3) B3 (Brain).
Level of consciousness, usually compost mentis.
Examination of cerebral function. Mental status: observation of
appearance and client behavior. Usually the mental status does not
change.
Examination of cranial nerves:
Nerves I. In clients with femoral fractures, nerve function 1 is not
abnormal. The olfactory function has no kelaianan.
Nerve II. After testing, the sharpness of vision is normal.
Nerves III, IV, and VI. Usually there is no interference with
lifting the isocorous eyelids and pupils.
V. nerve client fracture of the femur generally does not experience
paralysis of the facial muscles and there is no
abnormality in the corneal reflex.
Neural VII. Taste perception in normal and symmetrical face.
Nerves VIII. There was no evidence of conductive deafness and
deafness.
Nerves IX and X. good swallowing ability.
Nerves XI. There is no sternocleimastoid and trapezius muscle
atrophy.
Nerves XII. The tongue is symmetrical, there is no deviation on
one side and no fasciculation. Indra is normal tasting.
Reflex check. Pathologic reflexes are usually not found.
Sensory examination. The client's feeling of fracture of the femur
is reduced especially in the distal part of the fracture, while the
other senses and their cognitive are not impaired. In addition,
pain arises from fracture.
(4) B4 (Bladder). Assess urine conditions including the color,
amount, and characteristics of urine, including urine specific
gravity. Usually clients of femoral fractures do not experience
abnormalities in this system.

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 (5) B5 (Bowel). Abdominal inspection: flat, symmetrical, no hernia.
Palpation: good turgor, no masculine defenses and the liver is not
palpable. Percussion: tympanic sound, there is a reflection of fluid
waves. Auscultation: normal intestinal peristastic ± 20 times /
minute. Anal genitalia: no hernia, no lymph enlargement, and no
difficulty in bowel movements.
(6) B6 (Bone). The presence of a fracture in the femur will interfere
locally, both motor, sensory and circulatory functions.

Look. In the system integument there is erythema, the temperature

around the area of trauma increases, swelling, edema, and
tenderness. Pay attention to unusual (abnormal) swelling and
deformity.
Feel. Assess for tenderness and crepitus in the thigh area.
Move. After the feel inspection, the examination is continued by
moving the extremity, then the nurse notes whether the complaint
of pain in the movement. This recording of vulnerable movements
needs to be done in order to evaluate the conditions before and
after.
c. Nursing Diagnosis
The main nursing problems in femoral fractures, both open and
closed fractures are as follows:
1) Acute pain associated with physical injury agents, muscle spasm,
movement of bone fragments, edema, soft tissue injury, traction
installation.
2) Barriers to physical mobility are associated with neuromuscular
skeletal damage, pain, restrictive therapy (immobilization).
3) Risk of infection associated with trauma, primary body immunity
decreases, invasive procedure (traction installation).
4) Anxiety is associated with situational crises, economic status, and
changing role functions.

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d. Nursing Plans
1) Acute pain is related to physical injury agents, muscle spasm,
movement of bone fragments, edema, soft tissue injury, installation of
traction The
purpose of treatment: reduced pain, loss, or resolution.
Criteria results: subjectively, clients report reduced or manageable
pain, identifying activities that increase or reduce pain.
The client is not nervous. Pain scale 0-1 or resolved.
Intervention:
a. Individual
1. Assess pain with a scale of 0-4
Rational: Pain is a subjective response that can be assessed using
the pain scale. Clients report pain usually above the level of
injury.
2. Adjust the position of immobilization in the thigh
Rational: Adequate immobilization can reduce the movement of
bone fragments which are the main elements causing pain in the
thigh area
3. Help the client in identifying trigger factors
Rational: Pain is affected by anxiety, tension, temperature,
bladder distension, and lying down for a long time.
4. Explain and help clients related to non farmacological pain
relief measures
Rational: Approach using relaxation techniques and other
nonfarmacology is effective in reducing pain
5. Teach deep breathing relaxation: techniques to reduce skeletal
muscle tension that can reduce pain intensity.
Rational: This technique will accelerate blood circulation so
that the need for o2 on the tissue is fulfilled and the pain is
reduced
6. Teach the method of distraction during acute pain
Rational: Transfer the client's attention to pain to pleasant
things
7. Give a comfortable position, such as sleep time

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 Rational: Istrahat relaxes all network so that it will increase
comfort
8. Increase knowledge about the causes of pain and connect with
some pain that will last Rational: Knowledge of the causes of
pain helps reduce pain. This can help improve client
compliance with therapeutic plans
9. Observation of pain levels and motoric response of clients 30
minutes after administration of analgesic drugs to assess their
effectiveness in 1-2 hours
Rational: With optimal assessment, nurses will obtain objective
data to assess possible complications and do appropriate
interventions
b. Collaborative
1. Giving analgesics.
Rational: Analgetik blocks the trajectory of pain so that pain will
decrease.
2. Installation of skin traction or bone traction.
Rational: Effective traction will have an impact on decreasing the
shift in bone fragments and providing a good position for bone
reassignment.
3. Operation for installation of internal fixation.
Rational: Internal fixation can help immobilize the fracture of
the femur so that the movement of fragments decreases.
2) Barriers to physical mobility are associated with neuromuscular
skeletal damage, pain, restrictive therapy (immobilization).
Treatment goals: the client is able to carry out physical activities
according to his abilities
Criteria results: clients can participate in training programs, do not
experience joint contractures, muscle strength
increases, and spleen shows actions to improve
mobility.

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 Intervention
a. Individual
1. Assess existing mobility and observe any increase in
damage. Regularly assess motor function.
Rational: Knowing the level of ability of clients in carrying
out activities.
2. Adjust the position of immobilization on the thigh.
Rational: Adequate immobilization can reduce the
movement of bone fragments which are the main elements
causing pain in the thighs.
3. Teach clients to exercise active movements in the non-
aching extremities.
Rational: Active movements provide muscle mass, tone, and
strength, and improve heart and respiratory function.
4. Help clients do ROM exercises and self-care according to
tolerance.
Rational: To maintain joint flexibility according to the
ability of
a. collaboration
Collaboration with physiotherapists for client physical
exercise Rational: The ability of mobility mobilization can
be improved by physical exercise from the physiotherapy
team The
3) risk of infection associated with trauma, primary body immunity
decreases, invasive procedure (traction installation).
Treatment goals: infection does not occur during treatment
Criteria results: clients recognize risk factors, recognize preventive
measures / reduce risk factors for infection, and
demonstrate / demonstrate techniques to improve a
safe environment.

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 Intervention
a. Individual
1. monitor surgical wounds every day.
Rational: Early detection of inflammatory symptoms that
may arise secondary to postoperative wounds.
2. Perform wound care sterile.
Rational: Sterile wound care techniques can reduce bacterial
contamination
3. Monitor or limit visits.
Rational: Reducing the risk of contact infection from other
people.
4. Self-care assistance and activity limitations according to
tolerance. Help exercise program. Rational: Demonstrate
general abilities, muscle strength, and stimulate the return of
the immune system.
b. Collaboration
Give antibiotics as indicated
Rational: One or more agents are given that depend on the nature of
the pathogen and the infection that occurs.
4) Anxiety is associated with situational crises, economic status, and
changing role functions.
Treatment goals: anxiety is lost or reduced.
Criteria results: the client knows his feelings, can identify the causes or
factors that influence him, and states anxiety is lost or
diminished
Intervention
a. Individual
1. Assess anxiety and nonverbab signs of anxiety, accompany
clients, and take action if the client shows destructive behavior.
Rational: Verbal / nonverbal reactions can show a sense of
agitation, anger and anxiety.
2. Avoid confrontation.
Rational: Confrontation can increase anger, reduce cooperation,
and possibly slow healing.

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 3. Start doing actions to reduce anxiety. Give a quiet environment
and restful atmosphere.
Rational: Reducing unnecessary external stimuli.
4. Increase client sensation control.
Rational: Control client sensations by providing information
about the client's condition, emphasizing respect for positive
coping sources, helping relaxation exercises and diversion
techniques, and providing positive feedback.
5. Orient the client to the stages of the expected operating
procedures and activities.
Rational: Orientation of the stages of surgical procedures can
reduce anxiety.
6. Give the client the opportunity to express his anxiety.
Rational: Can eliminate tension against concerns that are not
expressed.
7. Give privacy to the closest clients and people.
Rational: Give time to express feelings, eliminate anxiety, and
adaptive behavior. The existence of family and friends chosen
by clients to carry out activities and diversion.
b. Nursing Implementation
Implementation is the fourth step of the nursing process where at this
stage the actions planned by nurses are carried out in helping patients prevent,
reduce and eliminate the impact or response caused by nursing and health
problems.
c. Evaluation
Evaluation is expected nursing care results is resolved pain,
fulfillment of movement / physical mobility, avoid the risk of
postoperative infections and reduced anxiety.

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 NURSING CARE

The results of a case study of a picture of nursing care at D with a right femoral 1/3
proximal fracture that was carried out on 09 - 11 July 2018 in the Laika Waraka Surgery
Room at Bahteramas General Hospital, Southeast Sulawesi Province. Nursing care starts
from the assessment, nursing diagnosis, planning, implementation, and evaluation.

Assessment
a. Client Biodata
Name : Mr. D
Age : 36 years old
Gender : male
Address : kec. Molawe, district. North Konawe
Tribe / Nation : Tolaki / Indonesia
Marital Status : Unmarried
Religion : Islam
Occupation : Building Kuli
Medical Diagnosis : femur fracture 1/3 proximal right to
No. Medical Record : 53-29-95
Entry Date : July 3, 2018
Assessment Date : July 9, 2018
b. Responsible Person
Name : Ny. B
Age : 54 Years
Gender : Female
Occupation : farmer
Relationship with Clients: parent (mother)

Client entered hospital on July 3, 2018 Hours 13.10 Time. The assessment was
carried out on July 9, 2018 at 8:30 a.m. obtained through direct observation, physical
examination, review of medical records and nurse records. The main complaint is felt, the
client complains of pain in the legs of the right thigh part after surgery, pain such as stabbing,
scale of pain 4, pain arises when moved, the client looks nervous, grimacing facial
expressions ..

17
 Medical history now the client enters Bahteramas Hospital through referral from
District Hospital. Konawe Utara, a client is hit by wood while working. Then the client enters
through the General Hospital of the Bahteramas Hospital, while at the client's emergency
room complains of pain in the extremity of the right leg thigh. Clients get RL infusion
therapy 20 drops per minute, and staining. X-rays of the right lower extremity are fractured
femur 1/1 proximal right. After that the client is taken to the surgical room at 16.30 for
treatment and waiting for the surgery schedule. The operation was carried out on July 4, 2018
at 10:00 a.m. It was finished at 12:30 a.m.
Previously the client had experienced fever. Family health history, the client said that
in family members no one suffered from hereditary diseases such as diabetes mellitusand
hypertension. In the family tree, Mr. D is the first child of the siblings.
The results of the client's general condition inspection are weak The level of
awareness of the client is fully aware (compos mentis) with the value of the Glasglow
Coma Scale (GCS): 15 (eye 4, verbal 5, motoric 6). The results of examination of vital
signs are as follows, blood pressure 110/70 mmhg, pulse 68 times per minute with a
regular and strong rhythm, respiratory frequency 20 times per minute with regular rhythm,
and temperature 36.5o C.
Assessment of comfort needs, causes of pain are direct trauma from being hit by
wood at work and then after surgery, the area of pain is in the former area of operation on
the right leg of the right proximal 1/3, with the intensity of pain 4 (moderate pain), the
quality of pain such as stabbing , pain is felt when the right foot is moved, the client looks
nervous with a grimacing facial expression, the client has never suffered from a disease /
trauma that caused previous pain.
The effect of pain on rest and sleep, before the client's illness said to sleep
approximately 7-8 hours a day, from 9:00 a.m. to 5:00 a.m. Clients say sometimes also
take a nap approximately 2 hours a day. During the illness the client said that he could not
sleep well because he was disturbed due to feeling pain.
Perceptual cognitive pattern, before the client's pain says vision, hearing, and
speaking clearly. During the illness the client said he could communicate well. There is no
visual impairment, able to be fully oriented to the environment, identify the state of the
person, the situation with full awareness, and no other symptoms that accompany pain.
Supporting investigations are radiological (x-ray), and laboratory examinations. On
laboratory tests conducted on July 4, 2018 Hemoglobin results were 15.0 g / dl, hematrokit
50.0%, erythrocytes 6.34 million / mm3, leukocytes 25,100 / mm3, platelets 343,000 U / L,

18
basophils 0, 2%, eosinophil 1.0%, neutrophils 44.7%, lymphocytes 92.6%, monocytes
2.9%, MCV 80 fL, MCH 25 pg, MCHC 32%, blood group B / Rh (+), bleeding period BT
02'10 '' minutes, freezing period CT 06'15 '' minutes, HBsAg qualitatively negative, blood
glucose when 107 mg / dl.
The results of the X-ray examination on July 3, 2018 in the right lower extremity
have a fracture of the right proximal 1/3 1/3. The treatment program obtained by the client
was on the 9th of July 2018, namely infusion of RL 20 tpm (drops per minute), ketorolax 1
amp / 12 hours through intravenous injection

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Data analysis
Patient name: Mr. D
Age: 36
Yrs RM: 53-29-95
No. Symptoms of Etiology Problem

1. Ds: Direct trauma Acute pain

- Client complains of pain in the

leg of the right thigh part

- Pain is felt after surgery

- Pain like stabbing

Fracture
- Scale of pain 4

- Pain arises when right foot is

Doped

Shift of bone fragments

Do:

- General condition is weak

- Consciousness composment

- Client looking nervous

Acute
- grimacing facial expression

- at the lowerthigh

rightis attached to the container

extremity the(draine) and the

turban

- the x-ray results in a fracture

of the right 1/8 proximal.

20
- Vital Signs:

BP: 110/70 mmHg S: 36,5oC

HR: 68 x / minute

RR: 20x / minute

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 Nursing Diagnosis

Patient name: Mr. D

Age: 36
Yrs RM: 53-29-95

No. Diagnosis ofTreatment Paraf

1. Acute pain associated withinjury agents ₰

physical: post op ORIF characterized by:

Ds:

- Client complains of pain in thethigh part of the leg

right

- Pain is felt after surgery

- Pain like stabbing

- Scale of pain 4

- Pain arises whenright foot is moved

Do's:

- General condition is weak

- Awareness of composmentis

- Client looks agitated

- Expression of grimace

- At the lowerright thigh is attached a

extremity ofcontainer (draine) and Turban

- The x-ray results in fracture

22
of the right 1/8 proximal.

- Vital Signs:

BP: 110/70 mmHg T: 36,5oC

HR: 68 x / minute RR: 20x / minute

23
Nursing Interventions

Objective and
diagnosis Intervention
No. outcome criteria Rational
Nursing (NIC)
(NOC)

1. Acute pain After 1. Assess pain 1. to

associated action 2. Monitor find out

withagent nursingin signs the level of

pain
physical 3 x 24 hours, it is vital
injury: felt by the
expected that pain 3. Giveposition
post op client
decreases with a comfortable
ORIF
2. to
the results criteria: (semi fowler)
find out the
- The client 4. Teach
state of the
says the techniques
client
pain is reduced relaxation
3. so that the
- Pain scale 0-2 breathingin client

-facial expressions 5. Collaboration feels

with theteam comfortable
Relax
medicalin 4. to
- Clients can
administering reduce the
do
analgesic drugs pain
pain control
(ketorolax 1 felt by the
(breathing technique
client
amp / 12 hours)
deep)
5. so that the

24
- Vital Signs within limits patient's pain

normal decreases

BP: 110 / 70-

120/80

HR: 60-100

x / minute

Respiratory: 16-20

x / minutes

Temperature: 36-37oC.

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Implementation
Nursing
No. Date Implementation Paraf
Diagnosis

1. Acute pain Monday 1. Assess client pain ₰

associated July 09 Results: subjective response:

2018
withagent - Client says pain
08:30 pm
physical in the right thigh part of the leg
injury:
- Pain felt after
post op ORIF
surgery

- Pain is felt like

pricking

- Scale of pain 4

- Pain arises when moved

Objective response:

- Grimace facial expression

- Client appears nervous

- Right extremity is

attached to the container

(draine) and verban

- X-ray results there is

fracture of theproximal

right 1/8.

26
08.40 wita 2. Monitorsigns ₰

vital

Results: subjective response:

- Client says he is willing to

be tested for

blood pressure

Objective response:

BP: 110/70 mmHg

GR: 68x / minute

27
 RR: 20 x / minute

T: 36,5oC

08.45 wita 3. Give a position ₰

comfortable (semi fowler)

Results: subjective response:

- Clients say comfortable

with that position

given

Objective response

- Clients look comfortable with

position given

28
 08.50 wita 4. Teach techniques ₰

deep breath relaxation

Result: subjective response

- Clients understand

with relaxation techniques

taught.

Objective response:

- Clients are able to do

relaxation techniques

independent

09.00 wita 5. Collaborate with the team ₰

medical in administering analgesic
drugs (ketorolax 1 amp / 12 hours)
Results: subjective response: - The
client said he was willing injected
Objective response - Injection via
intravenous and no allergies occur.

2. Accute Pain Tuesday 1. assess client pain Results: ₰

subjective response: - Clients say
July 10,
pain on the legs of the thighs to
2018
the right - Pain is felt after
8:00 a.m. operation - Pain is felt like stabbed
- Scale of pain 3 - Pain arises
when moved Objective response: -
expression grimacing - The client
seems nervous - Right-hand
extremity attached container
(draine) and verban - X-ray results

29
 are available femoral fracture 1/3
proximal right.

08. 10 wita 2. Monitorsigns ₰

vital

Results: subjective response:

- Client says he is willing to

be tested for

blood pressure

Objective response:

BP: 120/70 mmHg

GR: 80x / minute

RR: 20 x / minute

T: 36,5oC

08.35 wita 3. Give a position comfortable ₰

(semi fowler) Result: subjective
response - Clients say comfortable
with the position given Objective
response - Clients look
comfortable with position given

30
 08.40 wita 4. Teach techniques ₰
deep breath relaxation
Result: subjective response
- Clients understand
with relaxation techniques
taught.
Objective response:
- Clients are able to do
relaxation techniques
independent

08. 50 wita 5. Collaborate with the team ₰

medical treatment analgesic
(ketorolax 1 amp / 12 hours)
Results: subjective response: - The
client said he was willing injected
Objective response Injection via
intravenous and no allergies.

3 Accute Pain Wednesday 1. assess client pain ₰

Results: subjective response:
July 11,
- Clients say pain
2018
on the legs of the thighs
08.00 wita right side decreases
- Pain scale 2
Objective response:
- Relaxed facial expressions
- The client seems calm
- Right-hand extremity
attached container
(draine) and verban
- X-ray results are available
femoral fracture 1/3 proximal
right.

31
08.10 wita 2. Monitor signs vital Results: ₰
subjective response: - The client
said he was willing inspection
blood pressure Objective
response: BP: 120/80 mmHg HR:
72x / minute RR: 20 x / minute T:
36,5oC

08.15 wita 3. Give a position ₰

comfortable (semi fowler)
Results: subjective response:
- Clients say comfortable
with that position
given
Objective response
- Clients look comfortable with
position give
08.20 wita 4. Teach techniques deep breath ₰
relaxation Result: subjective
response - Clients understand with
relaxation techniques taught.
Objective response: - Clients are
able to do relaxation techniques
independent

32
Evaluation
No. Day/ Date Diagnosis Evaluation Paraf

1. Monday Acute pain S: ₰

July 9, 2018 - Clients say pain on
associated
foot of the next thigh section
withagent right
- Pain felt after surgery
physical
- Pain is felt like
injury:
stabbed
post op - Scale of pain 4
ORIF - Pain arises when moved
O:
- expression grimacing
- The client seems nervous
- Right-hand extremity
attached container (draine)
and verban
- X-ray results in a fracture
the right femur proximal 1/3.
Vital Sign:
BP: 110/70 mmHg
HR: 68x / minute
RR: 20 x / minute
T: 36,5oC
A: The problem has not been resolved
P: Interventions 1,2,3,4,5 in
continue.
2. Tuesday Acute pain S: ₰
- Clients say pain on
July 10, 2018 associated
foot of the next thigh section
. withagent right

33
 physical - Pain felt after surgery
injury: - Pain is felt like
stabbed
post op
- Scale of pain 3
ORIF
- Pain arises when moved
O:
- expression grimacing
- The client seems nervous
- Right-hand extremity
attached container (draine)
and verban
- X-ray results in a fracture
the right femur proximal 1/3.
- Vital Sign:
BP: 110/70 mmHg
HR: 68x / minute
RR: 20 x / minute
T: 36,5oC
A: The problem is partially resolved.
P: intervention 1,2,3,4 in
continue.
3. Wednesday Acute pain S: - Clients say pain on foot of the ₰
next thigh section right decreases -
July 11, associated
Pain scale 2 O: - Relaxed facial
2018
withagent expressions - The client seems calm -
Right-hand extremity attached
physical
container (draine) and verban - X-ray
injury:
results in a fracture the right femur
post op proximal 1/3. - Vital Sign:
ORIF BP: 110/70 mmHg
HR: 68x / minute
RR: 20 x / minute

34
T: 36,5oC
A: The problem is resolved. Q:
Intervention is stopped.

35
 References

Husni, 2010. Teknik Keselamatan dan Kesehatan Kerja Industri. Yogyakarta Graha Ilmu.

Undang-Undang republik Indonesia Nomor 1 Tahun 1970 Tentang Keselamatan Kerja,

(1970).

Helmie, 2012. Buku Saku Kedaruratan Dibidang Bedah Ortopedi. Jakarta : Salemba
Medika

Muttaqin,Arif.2010. Asuhan Keperawatan Klien Gangguan Sistem Muskuloskeletal.

Jakarta: EGC

Padila. 2012. Buku Ajar Keperawatan Medikal Bedah. Yogyakarta: Nuha Medika

NANDA, 2015. Diagnosis Keperawatan Definisi & Klasifikasi 2015-2017. Edisi 10.
Jakarta: EGC

xxxvi
 QUESTION

1. Name : Amelia Khairani Damayanti

ID Card : 1610012
Group :1
Lack of attation to patient safety in PHC. How do disiplin ?

2. Name : Putri Ayu Septianing

ID Card : 1610086
Group :2
How to improve patient safety at hospital ?

3. Name : Puput Kurniawati

ID Card : 1610082
Group :4
Diagnosis take acute pain ?

4. Name : Hernindya Diajeng Ayu Anggraini

ID Card : 1610042
Group :5
Time requiremenr of observation of patient using fall risk branket ?

5. Name : Oktarina Ayu permata Sari

ID Card : 1610080
Group :6
Faster for infection, henl to body? How to place needle for injection ?

6. Name : Avita Intan Safitri

ID Card : 1610018
Group :7
Painter 3X24 times ?

xxxvii
7. Name : Norma Widya Afriani
ID Card : 1610076
Group :8
Discharge plasis for patient of risk falling for at home ?

8. Name : Nishrina Widya Sukma

ID Card : 1610074
Group :9
Nurse who doesn’t care of risk falling for at home ?

9. Name : Miftachul Jannah

ID Card : 1610062
Group : 10
Patient don’t agree with action with SOP ?

xxxviii